I was taught early that you shouldn’t cut off your nose to spite your face. In other words, don’t engage in destructive action just because you’re angry at someone, because you usually end up hurting yourself more than the other person.

I wish our elected leadership had remembered that during their consideration of whether the state should accept billions of dollars from the federal government to expand Medicaid coverage for low-income families. This expansion of Medicaid is a key provision of the Affordable Care Act, known more familiarly as Obamacare.

The law provides that for three years, beginning in 2014, the federal government must pay 100 percent of a state’s costs of expanding Medicaid so that more people who can’t afford health insurance will have access to medical care. After that three-year period, the federal government is required to continue paying 90 percent of the costs associated with expanded Medicaid, while the state picks up the other 10 percent.

States can choose whether to accept that federal money or not. If Gov. Nathan Deal said yes to the offer, it would result in more than $3 billion in federal funds flowing into Georgia this year. 

Deal has refused to accept the money to expand coverage, even though such health care groups as the Medical Association of Georgia and the Georgia Hospital Association support expansion. The governor recently signed a bill transferring the authority for that decision from his office to the General Assembly, which means the state likely will never take the money.

Other governors have accepted the federal funds, including such Republican chief executives as Rick Snyder of Michigan, Jan Brewer of Arizona, Chris Christie of New Jersey and Terry Branstad of Iowa. Brewer, who probably dislikes President Obama as much as any Republican governor does, had to browbeat a GOP-controlled legislature to get approval for the federal funds, but after she succeeded she remarked, "It was a win, win, win all the way around." When Christie made the decision to accept federal money for New Jersey, he said, “We are putting people first. Which is why, after considerable discussion and research, I have decided to participate in the Medicaid expansion under the Affordable Care Act.”

Deal and the legislative leadership in Georgia have taken the opposite course, and I think a large factor in their decision is political spite towards a Democratic president. What better way to express that spite than to slap the hand offering you billions of dollars in federal money?

There is always a price to pay for this kind of behavior, as it turns out. The widespread media coverage of the Obamacare implementation has prompted thousands of people to step forward to sign up for Medicaid coverage. In many cases, these are people who were already eligible for Medicaid coverage but were not aware of it—so they will get health care coverage even if their state does not participate in the Obamacare-funded expansion. Health care experts call this the “woodwork effect,” because these people have figuratively come out of the woodwork to sign up for Medicaid. A study released last week indicates that nearly 100,000 people in Georgia who had been eligible for Medicaid coverage all along signed up for the program as Obamacare was being rolled out in recent months.  It is estimated these new enrollees will require the state to pay about $90 million a year more for Medicaid expenses. 

That is where our elected leadership has put us. The state refuses to take more than $3 billion in federal funds for Medicaid expansion, but it is on the hook to pay another $90 million in Medicaid costs anyway. That doesn’t sound like a smart deal to me, but that’s what happens when your decisions are influenced by personal spite instead of logic and reasoning.